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https://www.readbyqxmd.com/read/29676223/opiate-free-tricuspid-valve-replacement-case-report
#1
Jeffrey P Cardinale, George Gilly
The utility of opioid pain medications for perioperative analgesia is well described. However, opioids have many dangerous side effects including respiratory depression, acute tolerance, hyperalgesia, and chronic opioid dependence. Multimodal approaches continue to be used in more invasive and complex surgical procedures for enhanced recovery and decreased postoperative complications from opioid administration. The current case report centers on a 30-year-old male recovering from opioid addiction presenting with severe tricuspid regurgitation scheduled to undergo a tricuspid valve replacement...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29671504/buprenorphine-therapy-for-opioid-use-disorder
#2
Roger Zoorob, Alicia Kowalchuk, Maria Mejia de Grubb
Opioid misuse, including the use of heroin and the overprescribing, misuse, and diversion of opioid pain medications, has reached epidemic proportions in the United States. As a result, there has been a dramatic increase in opioid use disorder and associated overdoses and deaths. Addiction is a chronic brain disease with a genetic component that affects motivation, inhibition, and cognition. Patient characteristics associated with successful buprenorphine maintenance treatment include stable or controlled medical or psychiatric comorbidities and a safe, substance-free environment...
March 1, 2018: American Family Physician
https://www.readbyqxmd.com/read/29643620/opioid-free-anesthesia-for-breast-cancer-surgery-an-observational-study
#3
Swagata Tripathy, Satyajit Rath, Suresh Agrawal, P Bhaskar Rao, A Panda, T S Mishra, Sukdev Nayak
Background and Aims: Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthesia with opioid-based general anesthesia for breast cancer surgery in a prospective cohort study. Material and Methods: Twenty four adult American Society of Anesthesiologists grade I-III patients posted for modified radical mastectomy (MRM) with axillary dissection were induced with propofol and maintained on isoflurane (0...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29624517/sources-of-opioid-medication-for-misuse-in-older-adults-results-from-a-nationally-representative-survey
#4
Ty S Schepis, Sean Esteban McCabe, Christian J Teter
Despite increasing rates of prescription opioid misuse in adults 50 years of age and older, little research has investigated such misuse in this population. This work aimed to examine sources of misused opioid medication in adults 50 years and older, with comparisons to younger groups. Data were from the 2009-2014 National Survey on Drug Use and Health surveys. Prevalence rates of prescription opioid sources, misuse, and prescription opioid use disorder (POUD) symptoms were estimated. Design-based logistic regression investigated age-based differences in these factors and the association of sources to POUD symptoms and other concurrent substance use...
April 5, 2018: Pain
https://www.readbyqxmd.com/read/29606583/cost-analysis-of-enhanced-recovery-after-surgery-in-microvascular-breast-reconstruction
#5
Christine Oh, James Moriarty, Bijan J Borah, Kristin C Mara, William S Harmsen, Michel Saint-Cyr, Valerie Lemaine
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital LOS and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and can potentially increase the quality of care while decreasing costs. METHODS: A standardized ERAS pathway was developed through multidisciplinary collaboration...
March 2, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29605483/severe-opioid-withdrawal-precipitated-by-vivitrol%C3%A2
#6
R S Wightman, L S Nelson, J D Lee, L M Fox, S W Smith
The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse...
March 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29575372/radar-plots-a-novel-modality-for-displaying-disparate-data-on-the-efficacy-of-eluxadoline-for-the-treatment-of-irritable-bowel-syndrome-with-diarrhea
#7
D M Brenner, L S Dove, D A Andrae, P S Covington, C Gutman, W D Chey
BACKGROUND: Patients with irritable bowel syndrome with diarrhea (IBS-D) experience a range of abdominal and bowel symptoms; successful management requires alleviation of this constellation of symptoms. Eluxadoline, a locally active mixed μ- and κ-opioid receptor agonist and δ-opioid receptor antagonist, is approved for the treatment of IBS-D in adults based on the results of 2 Phase 3 studies. Radar plots can facilitate comprehensive, visual evaluation of diverse but interrelated efficacy endpoints...
March 25, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29570970/sources-of-prescription-medication-misuse-among-young-adults-in-the-united-states-the-role-of-educational-status
#8
Sean Esteban McCabe, Christian J Teter, Carol J Boyd, Timothy E Wilens, Ty S Schepis
OBJECTIVE: This study examined prescription drug misuse (PDM), sources of PDM, and substance use disorder (SUD) symptoms as a function of educational status among US young adults based on a large nationally representative sample. METHODS: Data from the 2009-2014 National Survey on Drug Use and Health came from a sample of 106,845 young adults aged 18-25 years. Respondents were categorized by educational status and PDM, sources of PDM, other substance use, and SUD symptoms, with analyses performed separately for prescription opioids, stimulants, and sedatives/tranquilizers...
March 20, 2018: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/29541841/much-ado-about-nothing-the-effect-of-tourniquet-time-on-an-accelerated-rehabilitation-programme-following-total-knee-replacement-tkr
#9
William Wynell-Mayow, Muhammad Zahid Saeed
BACKGROUND: The WHO includes osteoarthritis as a disease of priority, owing to its significant impact on quality of life, and globally increasing prevalence. Hospital budgets are under pressure to ration knee replacements and shorten inpatient stays. Prolonged tourniquet application has been hypothesised to extend recovery through pain and reduced mobility. PATIENTS AND METHODS: A total of 123 elective total knee replacements meeting inclusion criteria took place from July 2015 to October 2017 at the Royal Free Hospital...
March 14, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/29518316/dissecting-the-innate-immune-recognition-of-opioid-inactive-isomer-naltrexone-derived-toll-like-receptor-4-tlr4-antagonists
#10
Xiaozheng Zhang, Fengchao Cui, Hongqian Chen, Tianshu Zhang, Kecheng Yang, Yibo Wang, Zhenyan Jiang, Kenner C Rice, Linda R Watkins, Mark R Hutchinson, Yunqi Li, Yinghua Peng, Xiaohui Wang
The opioid inactive isomer (+)-naltrexone is one of the rare Toll-like receptor 4 (TLR4) antagonists with good blood-brain barrier (BBB) permeability, which is a lead with promising potential for treating neuropathic pain and drug addiction. (+)-Naltrexone targets the lipopolysaccharides (LPS) binding pocket of myeloid differentiation protein 2 (MD-2) and blocks innate immune TLR4 signaling. However, the details of the molecular interactions of (+)-naltrexone and its derivatives with MD-2 are not fully understood, which hinders the ligand-based drug discovery...
March 8, 2018: Journal of Chemical Information and Modeling
https://www.readbyqxmd.com/read/29514747/scalp-blocks-for-brain-tumor-craniotomies-a-retrospective-survival-analysis-of-a-propensity-match-cohort-of-patients
#11
Juan P Cata, Shreyas Bhavsar, Katherine B Hagan, Radha Arunkumar, Ted Shi, Roxana Grasu, Anh Dang, Richard Carlson, Benjamin Arnold, Keyuri Popat, Yuri Potylchansky, Ian Lipski, Sally Raty, Anh T Nguyen, Thomas M McHugh, Lei Feng, Thomas F Rahlfs
To test the association between the use of scalp blocks for malignant brain tumor craniotomy and survival. This is a retrospective study conducted in a tertiary academic center. Demographic, intraoperative and survival data from 808 adult patients with malignant brain tumors was included in the analysis. Patients were divided in those who received an Intraoperative use of scalp block or not. The progression free survival (PFS) and overall survival (OS) rates were compared in patients who had and had not scalp blocks...
March 5, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29505087/pregnancy-and-the-opioid-epidemic
#12
Amy L Haycraft
Opioid use disorder (OUD) in pregnancy is increasing, which often results in poor maternal and neonatal outcomes including neonatal abstinence syndrome (NAS) as a result of lack of prenatal care and inadequate substance use disorder management. Practice guidelines have been developed to manage OUD during and after pregnancy for mother and baby, but barriers exist, limiting comprehensive implementation. To reduce the impact of OUD in pregnancy and associated maternal and neonatal sequela, implementing compassionate evidence-based care and a non-punitive response is needed...
March 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
https://www.readbyqxmd.com/read/29504554/new-solvates-of-the-drug-naltrexone-protonation-conformation-and-interplay-of-synthons
#13
Karolina de Oliveira Gonçalves, Leandro Ribeiro, Cecilia Maria Alves de Oliveira, Jesiel Freitas Carvalho, Felipe T Martins
Naltrexone [systematic name: (4R,4aS,7aR,12bS)-3-cyclopropylmethyl-4a,9-dihydroxy-2,4,5,6,7a,13-hexahydro-1H-4,12-methanobenzofuro[3,2-e]isoquinolin-7-one] is an important morphine-related drug used for combating alcoholism and opioid dependence. Of the eight crystal forms of naltrexone known thus far, only one exists in the neutral form and it crystallizes as a monohydrate. We have isolated the naltrexone free base as two new solvate forms, i.e. the ethyl acetate 0.33-solvate, C20 H23 NO4 ·0.33C4 H8 O2 , (I), and the diethyl ether hemisolvate, C20 H23 NO4 ·0...
March 1, 2018: Acta Crystallographica. Section C, Structural Chemistry
https://www.readbyqxmd.com/read/29498534/low-dose-nocturnal-dexmedetomidine-prevents-icu-delirium-a-randomized-placebo-controlled-trial
#14
Yoanna Skrobik, Matthew S Duprey, Nicholas S Hill, John W Devlin
RATIONALE: Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear. OBJECTIVES: To determine if nocturnal dexmedetomidine prevents delirium and improves sleep in critically ill adults. METHODS: This two-center, double-blind, placebo-controlled trial randomized 100 delirium-free critically ill adults receiving sedatives to receive nocturnal (21:30 to 6:15h) intravenous dexmedetomidine (0...
March 2, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29463006/long-term-oncologic-outcomes-opioid-use-and-complications-after-esophageal-cancer-surgery
#15
Tak Kyu Oh, Kwhanmien Kim, Sang Hoon Jheon, Sang-Hwan Do, Jung-Won Hwang, Young-Tae Jeon, Kooknam Kim, In-Ae Song
Effective and adequate opioid use and prevention of postoperative complications are important for enhanced recovery after surgery. We examined the effects of postoperative opioid use and postoperative complications on overall survival and recurrence-free survival after esophageal cancer surgery. This retrospective cohort study analyzed the records of patients diagnosed with esophageal cancer who underwent the Ivor Lewis operation between January 2005 and December 2011. We collected data on total opioid use for 8 days postoperatively, as well as information on postoperative complications (Clavien-Dindo classification)...
February 19, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29460668/personal-control-over-decisions-to-participate-in-research-by-persons-with-histories-of-both-substance-use-disorders-and-criminal-justice-supervision
#16
Donna T Chen, Tomohiro M Ko, Ashleigh A Allen, Richard J Bonnie, Colleen E Suratt, Paul S Appelbaum, Edward V Nunes, Peter D Friedmann, Joshua D Lee, Michael S Gordon, Ryan McDonald, Donna Wilson, Tamara Y Boney, Sean M Murphy, Charles P O'Brien
Individuals must feel free to exert personal control over decisions regarding research participation. We present an examination of participants' perceived personal control over, as well as reported pressures and threats from others, influencing their decision to join a study assessing the effectiveness of extended-release naltrexone in preventing opioid dependence relapse. Most participants endorsed a strong sense of control over the decision; few reported pressures or threats. Although few in number, participants' brief narrative descriptions of the pressures and threats are illuminating and provide context for their perceptions of personal control...
February 1, 2018: Journal of Empirical Research on Human Research Ethics: JERHRE
https://www.readbyqxmd.com/read/29451418/patient-narratives-in-yelp-reviews-offer-insight-into-opioid-experiences-and-the-challenges-of-pain-management
#17
Rachel L Graves, Jesse Goldshear, Jeanmarie Perrone, Lyle Ungar, Elissa Klinger, Zachary F Meisel, Raina M Merchant
AIM: To characterize Yelp reviews about pain management and opioids. METHODS: We manually coded and applied natural language processing to 836 Yelp reviews of US hospitals mentioning an opioid medication. RESULTS: Yelp reviews by patients and caregivers describing experiences with pain management and opioids had lower ratings compared with other reviews. Negative descriptions of pain management and opioid-related experiences were more commonly described than positive experiences, and the number of themes they reflected was more diverse...
March 1, 2018: Pain Management
https://www.readbyqxmd.com/read/29441714/time-dependent-regional-brain-distribution-of-methadone-and-naltrexone-in-the-treatment-of-opioid-addiction
#18
Belin G Teklezgi, Annapurna Pamreddy, Sooraj Baijnath, Hendrik G Kruger, Tricia Naicker, Nirmala D Gopal, Thavendran Govender
Opioid addiction is a serious public health concern with severe health and social implications; therefore, extensive therapeutic efforts are required to keep users drug free. The two main pharmacological interventions, in the treatment of addiction, involve management with methadone an mu (μ)-opioid agonist and treatment with naltrexone, μ-opioid, kappa (κ)-opioid and delta (δ)-opioid antagonist. MET and NAL are believed to help individuals to derive maximum benefit from treatment and undergo a full recovery...
February 14, 2018: Addiction Biology
https://www.readbyqxmd.com/read/29398161/analgesic-use-and-risk-for-acute-coronary-events-in-patients-with-osteoarthritis-a-population-based-nested-case-control-study
#19
Caridad Pontes, Josep Ramon Marsal, Josep Maria Elorza, Maria Aragón, Daniel Prieto-Alhambra, Rosa Morros
PURPOSE: Recent controversies on the safety profiles of opioids and paracetamol (acetaminophen) have led to changes in clinical guidance on osteoarthritis (OA) management. We studied the existing association between the use of different OA drug therapies and the risk for acute coronary events. METHODS: A cohort of patients with clinically diagnosed OA (according to ICD-10 codes) was identified in the SIDIAP database. Within the cohort, cases with incident acute coronary events (acute myocardial infarction or unstable angina) between 2008 and 2012 were identified using ICD-10 codes and data from hospital admission...
February 2, 2018: Clinical Therapeutics
https://www.readbyqxmd.com/read/29397646/scientific-evidence-for-the-addictiveness-of-tobacco-and-smoking-cessation-in-tobacco-litigation
#20
Sungwon Roh
Smokers keep smoking despite knowing that tobacco claims many lives, including their own and others'. What makes it hard for them to quit smoking nonetheless? Tobacco companies insist that smokers choose to smoke, according to their right to self-determination. Moreover, they insist that with motivation and willpower to quit smoking, smokers can easily stop smoking. Against this backdrop, this paper aims to discuss the addictive disease called tobacco use disorder, with an assessment of the addictiveness of tobacco and the reasons why smoking cessation is challenging, based on neuroscientific research...
January 2018: Journal of Preventive Medicine and Public Health, Yebang Ŭihakhoe Chi
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